Mental Health between Yesterday and Today

According to the World Health Organization (WHO), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

This definition represents substantial progress since, less than 20 years ago, mental health was still considered as simply the absence of disorders, with no regard to the stability of individuals, and to attain it, the mental health care system had to go through different stages including a national movement and a revolutionizing reform.

For centuries, religious or spiritual interpretation has defined the treatment of mentally disabled people in many societies. In the Middle Ages, people considered mental problems as demonic or supernatural possessions. The early medical explanations of madness did not encourage compassion or tolerance and the dominant view of mentally disturbed people as incurable sub-humans justified the poor living conditions.

It wasn’t until the mid 19th century that William Sweetser first introduced the term “mental hygiene” followed by the definition: “the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements”.

The subject gained more attention with the “mental hygiene” movement, which coincided with an abrupt rise of mental disorders after the WWII.

All of these actions brought to light the many problems that the health care system suffered from, and led to changes in the system.

One of the highlights of the reform was the decentralization^[1]. Before the implementation of this process, mental health services were solely provided by public institutions that treated a large population. The flaws of these institutions are well known: huge size, overcrowding, geographic isolation, involuntary confinement and depersonalization^[2].

The second revolutionizing change was the health finance reforms, due to the desire to improve access to health care and increase equity. Without adequate funding, people with mental disorders had access to fewer mental health services and existing services were stretched beyond capacity.

The situation hasn’t improved much since then. Today, mental disorders account for 13% of the global burden of disease (978 million people), and it’s maximal in young adults.

Mental health services are still widely underfunded as nearly 28% of countries do not have separate budgets for mental health. There is also no equity in the distribution of resources within the mental health sector, for example, 25% of countries do not have access to basic psychiatric medications at the primary care level and 37% do not have community-based mental health facilities, and even within countries there is an unequal distribution of facilities and professionals between rural and urban regions^[3].

Effective intervention is available but still inaccessible to the majority of those in need as, for nearly 70% of the world’s inhabitants, there is access to under one psychiatrist per 100 000 population.

Mental health, although not a new subject, is still undiscussed and overlooked in many countries, and despite the multiple efforts put into it, we’re still far from an efficient mental health care system, and it’s times like these when we realize how much we need it, with so much stress and anxiety. Well, you’re lucky to have us!! Stay tuned for tips on how to maintain a better health.

^[1] Decentralization is the transfer of responsibility for health service provision from central to local government structures (Cassels, 1995)

^[2] Goffman 1961

^[3] World Health Organization, 2001a

Sources:

Promoting mental health, WHO

Origins of Mental Health – About Us – Mental Health – Departments

Mental Health, Wikipedia

THE MENTAL HEALTH CONTEXT,  WHO

Mental Health